Precertification
Precertification helps make sure you receive medically necessary care.
What requires precertification?
Some kinds of care in the contracted and non-contracted provider options require precertification, such as inpatient care and some outpatient procedures1. This includes using the PHCS Network in Hawaii or other Kaiser Permanente states for some services and procedures2. If using the PHCS Network of contracted providers, you are responsible for obtaining precertification. You must call 1-888-529-1553 (TTY 711) and press 2 for precertification. You may call Monday through Friday 6 a.m. to 4:30 p.m. HST for precertification. You may request precertification 24 hours a day, seven days a week, for urgent requests. For a complete list of services that require precertification, you can check the Pre-Certification Code Check. If using the Cigna HealthcareSM PPO Network for care in non-Kaiser Permanente states (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required3. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.
How do I receive precertification?
- Your physician, hospital, or authorized representative may obtain precertification for you.
- Contact Permanente Advantage at 1-888-529-1553 (TTY 711) and press 2 for precertification. You may request precertification 24 hours a day, seven days a week, for urgent requests.
- To learn more, visit www.kp.org/providers/kppa, or review the precertification section in your Evidence of Coverage (EOC)/Certificate of Insurance (COI) for details.
- Some kinds of care in the contracted and non-contracted provider options require precertification, such as inpatient care and some outpatient procedures. This includes using the PHCS Network in Hawaii or other Kaiser Permanente states for some services and procedures. If using the PHCS Network of contracted providers, you are responsible for obtaining precertification. You must call 1-888-529-1553 (TTY 711) and press 2 for precertification. You may call Monday through Friday 6 a.m. to 4:30 p.m. HST for precertification. You may request precertification 24 hours a day, seven days a week, for urgent requests. For a complete list of services that require precertification, you can check the Pre-Certification Code Check. If using the Cigna HealthcareSM PPO Network for care in non-Kaiser Permanente states (outside of CA, CO, GA, HI, MD, OR, VA, WA and DC), the Cigna PPO providers are responsible for obtaining precertification on your behalf when precertification is required. You won’t be financially responsible if a Cigna PPO provider fails to obtain precertification for covered services.
If you don’t obtain precertification for contracted and non-contracted provider option services when required, the services may be subject to a reduction in benefits otherwise payable. If the service is deemed not to have been medically necessary, you may have to pay the entire expense. Benefit reduced due to the application of a penalty will not apply toward your deductible and annual out-of-pocket maximum. So, it’s really important to get precertification. To learn more, review the precertification section in your Certificate of Insurance for details.
Need precertification?
Call this number: 1-888-529-1553 (TTY 711)
Access the Permanente Advantage Precertification Request Form to download.
1Contracted providers include other Hawaii providers directly contracted by Kaiser Permanente of Hawaii.
2For the Contracted Provider Network, Kaiser Permanente Insurance Company (KPIC) has contracted with PHCS, Inc a subsidiary of MultiPlan, Inc. The list of contracted PHCS Network providers is subject to change without notice.
3The Cigna Healthcare PPO Network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna Healthcare PPO for Shared Administration. Cigna HealthcareSM is an independent company and not affiliated with Kaiser Foundation Health Plan, Inc., and its subsidiary health plans. Access to the Cigna Healthcare PPO Network is available through Cigna Healthcare’s contractual relationship with the Kaiser Permanente health plans. The Cigna Healthcare PPO Network is provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company. The Cigna Healthcare name, logo, and other marks are owned by Cigna Intellectual Property, Inc.